rubber band ligation

(hemorrhoid banding)

A procedure in which the internal hemorrhoid is tied off at its base with rubber bands, cutting off the blood flow to it, causing it to wither and drop off.

The hemorrhoid is grapsed with a ligator through an anoscope inserted into the anus, then the ligator slides its cylinder upward and releases rubber bands around the base of the hemorrhoid.

It is performed for 1st-degree, 2nd-degree, and some cases of 3rd-degree hemorrhoids when the patient complains of bleeding or prolapse of hemorrhoids. It may also be considered for bleeding in severely anemic patients with 4th-degree hemorrhoids who are unfit for surgery.

(Treatment options for hemorrhoids)
• rubber band ligation: Grades 1-3 hemorrhoids, in an office setting.
• excisional hemorrhoidectomy: Grade 3-4, recurrent, or symptomatic hemorrhoidal disease.

Mild pain after the procedure is the most common complication. Secondary bleeding normally occurs 10-14 days after the procedure, and patients taking anti-platelet and/or anti-coagulant medication have a higher risk, including the possibility of massive life-threatening haemorrhage.
The patient should avoid constipation, drink ample water, be physically active, add fiber to the diet, and refrain from using narcotic pain medication. It is necessary to avoid heavy lifting and straining with bowel movements during recovery.

(Complications after the procedure)
• post-procedure pain
• fullness in the lower abdomen
• tenesmus (feel to have a bowel movement)
• rectal bleeding
• vasovagal syncope
• slippage of bands
• priapism (prolonged erection of the penis)
• anal fissure
• chronic longitudinal ulcers
• thrombosed hemorrhoids
• urinary retention
• pelvic sepsis
• death due to infection

(Comparison)
• rubber band ligation: Uses forceps to grasp and a ligator to apply a rubber band. Conventional.
• CRH O'Regan hemorrhoid banding system: Uses gentle suction to apply a rubber band.